ICBC - Chiro

ICBC has launched some exciting changes for billing Chiropractic services. As of April 1, 2019 :

Claims billed per service date will no longer be billed through MSP/Teleplan

Claims are no longer eligible to be billed under the Flat Fee Program

All claims billed to ICBC for Chiropractic care will follow the same style of billing with a pre-determined amount billed on a patient’s first visit and separate amount billed for each service date thereafter.

If you’re new to billing Chiropractic services to ICBC, you’ll first want to ensure that you have a Vendor Number. If you’re unsure whether or not you have a Vendor Number, you’ll want to contact ICBC. You can do so through their feedback form here

Create an Insurer

If you’ve been previously billing your ICBC claims through Teleplan, you will want to leave your existing ICBC (Teleplan) insurer as is in the event that you need to bill for claims pertaining to crashes that happened prior to April 1, 2019. It is also recommend that you leave your existing ICBC - Flat Fee insurer as is. Specific information about transitioning existing claims can be found a little further down this page.

In order to track and manage claims as of April 1, 2019, you’ll need to set up a new ICBC insurer. Insurers can be created by heading to Settings > Insurers > New Insurer

You’re going to choose the option Regular Insurance/3rd Party Payer/Lawyer because you won’t be submitting these claims via Teleplan.

You can call it something like “ICBC - Chiro”, and set the insurer’s default behaviour. If your fee schedule is higher per subsequent visit than what ICBC pays, you may choose to set either a user fee or set the insurer to default patient pays remaining so that the amount of the treatment not covered by ICBC is absorbed by the patient.

You may also find it helpful to include the link to the HCPIR portal in the field for Portal URL

If your clinic is a multi-disciplinary practice, it is recommended that you set up an ICBC insurer for each discipline. So, for example if you offer both Chiropractic and Massage Therapy services, you would have one insurer for ICBC - Chiro and one for ICBC - Massage. Each discipline does have a preauthorized number of treatments available and for patients seeking treatment with more than one discipline at the same clinic, it will be easier to keep track of the visit counts if each discipline is represented by a separate claim.

Create Custom Billing Codes

All though ICBC claims will no longer be submitted through Teleplan, ICBC has outlined that there is still a specific fee amount associated with a patient’s initial visit/report and a separate fee amount for each treatment thereafter.

Initial Visit & Report: $199

Subsequent Visits: $53 per treatment

Number of Preauthorized Treatments: 25

ICBC notes that:

“ICBC customers (patients) who choose to visit a health care practitioner that charges a higher rate than what ICBC funds under accident benefits (indicated above), will not be able to recover the user fees from ICBC for claims with a date of loss on or after April 1, 2019. This will mean that the patient is responsible for paying the user fee portion, which they may submit to their private health insurer for consideration of coverage.
Treatments are based on sessions provided and fees reflect fair market rate for a standard industry visit. Treatment frequency will be based on clinical recommendations and should reflect best practice. However, multiple sessions provided by the same discipline, on the same day, will not be funded.”

Custom billing codes can be created by heading to Settings > Billing Codes > New Billing Code

So like this :

Create a Claim

Once you have the insurer and custom billing codes created, you’re ready to begin building patient claims.

From the appointment pane, choose Add Claim and then Add New Claim/Policy.

Choose ICBC - Chiro from the list, and then continue to populate information into the claim template.

The only required field is the Claim Identification Number, which will be the patient’s ICBC claim number.

You’ll add the relevant maximums to the optional middle section. This section is where you’ll want to enter Maximum Number of Treatments as being 25 so that Jane will alert you when the amount/value has been reached.

Lastly, enter any Default Coverage Amounts that will be populated each time the claim is used - setting defaults can help save time for subsequent appointments that are billed the same each time.

It is recommended that here you enter the billing code that you’ve created to represent the fee amount billed for a subsequent treatment. You will need to override the billing code used on a patient’s first visit to be the billing code that represents the fee amount billed for the initial visit & report, however this step will only need to be done once per patient claim.

Transitioning Existing ICBC Chiro Claims

To transition your existing Chiropractic claims billed per service through Teleplan; on or after April 1, 2019 you’ll want to create a new claim for each active ICBC patient using the ICBC - Chiro insurer for non-Teleplan claims. It is recommended that you use the Claim Name field to indicate that the claim is effective April 1, 2019. If you have pre-booked appointments, with old claims attached, you will need to remove those claims and replace them with the newly created one.

When setting up the new claims, if the patient has an end date, or a pre-authorized number of treatments available, you’ll want to indicate those maximums in the new claim. For example : you have a patient that has 8 approved sessions left with an end date of May 31, 2019, you’ll want to set the Maximum Number of Treatments for the new claim at 8, and set the end date for May 31, 2019.

If services prior to April 1, 2019 still need to be billed and submitted, you will do so using the previous fee per service and those claims will be submitted through Teleplan. Teleplan will continue to accept ICBC Chiropractic claims for 18 Months after April 1, 2019 to allow for services prior to April 1, 2019 to be billed retroactively, and as well to allow rejected claims to be resolved and resubmitted.

For patients with an ongoing ICBC Flat Fee claim, you will continue tracking and managing these claims the same as you have been for the duration of the program.

Insure the Appointment

After saving the claim, you’ll now find the claim attached to the appointment under the “Insurer Info” section on the righthand side of your page.

You do not require as diagnostic code for every billing code. A patient’s diagnosis and any applicable clinical information will now be communicated to ICBC through the HCPIR web-based forms.

If all looks good with the claim, Arrive the appointment. From there, if the patient is due to pay a portion, you can proceed with collecting that payment using the Pay button

Managing the Insurer Invoice

ICBC claims for all disciplines are now managed like any other claim submitted through a portal. How you choose to manage the frequency in which claims are submitted is up to you. You may wish to submit each claim after the treatment has occurred, or you may find that it works better to let claims build up in your Unsubmitted folder and submit a bunch of claims at the same time.

If you prefer to submit each claim as or after the treatment is happening, if you’ve added the link to the HCPIR form to the “Portal URL” field of your ICBC insurer, then you can launch the portal from the Claim Screen.

From the Schedule click on the appointment to open the appointment pane to the right.

At the top of your page, below the patient’s name there is the insurer name in blue.

When you click on the blue words ICBC - Chiro you will launch the claim window including a link to the report:

After submitting the claim to ICBC, mark the invoice as submitted via the drop-down arrow next to its name:

This updates its state from Unsubmitted to Submitted.

You can also manage paper claims from Billing > Unsubmitted.

In the “Unsubmitted” folder, click the drop-down arrow next to an item line to Mark as Submitted, and it’ll subsequently move to the “Submitted” folder.

Now you wait for payment.

Reconciling Payment

It is our understanding that payments for ICBC claims will be directly deposited into the bank account used when enrolling for EFT (Electronic Fund Transfer)

When you receive confirmation from ICBC that payment has been received, you can record the payments in Jane using the New Payment workflow. If you’re unfamiliar with this workflow, please visit the guide document below.